Wednesday, May 9, 2012

Patients are not teenagers

Oh, I knew this article was going to get my Scottish up the moment I read the title: Being a physician is like trying to parent two thousand teenagers. Pretty insulting, no? But a good article title should want to make you read more, and pissing someone off is a great way to do that. I knew the article would give examples that would justify the title, and the author delivered. But I also knew I would have a lot to say on the matter. The doctor is the one ultimately in control of these conversations. If they're going badly, it's the person behind the wheel who's to blame. Here was my reply.

I may have a solution for you. Bring them over to your side. You know your right. And they will come to understand you're right too, if you can give them a clear picture of what's going on in your head.

I believe your issue is not your patients but the communication you have between your patients. Right now, I see both sides fighting to get their point of view heard. With the exception of the drug seeker (good catch, by the way!! It's great that Illinois has a registry like that), what I see is that your patients don't feel in control. You are trying to explain to them why you're right and they're wrong. But no one likes a lecture. They may be acting like teenagers because they're responding to you *treating* them like teenagers. What I hear you saying is, "No... you can't have this and here's why." Instead, why not try inviting them along your journey of decision making?

When patients come to you, they're in distress and they're scared. Of course they don't know as much as you. So you're going to have to help them, and be very gentle and patient with them. You have the education, but they're the ones who ultimately have to pay the price. They're depending on you to show them the correct course of action. If they feel that your goals and their goals are different, you're going to have conflict. My suggestion is slow your conversations down---this is an emotional minefield, laden with hidden traps. It may feel like you have to simplify your conversations and say some things that seem obvious. But nothing is obvious when people are upset and in need.

First, let them know that your goal is to see them---your patient---happy and healthy. Next, let them know that you understand the decision is up to them. You're going to provide information, and then they get to make the choice (even if the choice is to go to a different doctor because you won't prescribe). Let them know that you understand what they want: "I hear that you want me to prescribe these antibiotics. But first, can I let you in on my train of thought?" Then explain how you see the situation, what the options are, and what you see as potential problems. You can say things like, "I would *like* to give you this, but here's what I'm worried about." Lay out the consequences. Let them know why you're so worried about doing what they're asking. When they have all the evidence, they'll be able to make a good decision.

When it comes to end-of-life decisions, you have to know that people are going to become unreasonable. This is End of Life.... the stuff Elisabeth K├╝bler-Ross won 19 honorary degrees about. There is one simple question I would pose to that man: "How would you like your grandmother's final days to be? Do you want her hooked up to machines, being disturbed at all hours of the night for this and that... Or would you like her to be able to rest and have peaceful days surrounded by her loving family? Do you want her to have to fight a battle every day until her last?" Let him understand what he's asking for. He has no way of knowing how difficult it is. You said as much yourself. Explain what the consequences are *beyond* extending life.

You know these people would make the right decision if they knew what you knew. What you've forgotten is how long it took you to learn those things. Your patients only have these few moments in your presence to learn what you know. You had years of hard work. It's not reasonable to expect them to understand like you do. And you can't blame them for being skeptical of your answers---our culture is one of "buyer beware." Different doctors do different things---if one doctor did it this way and you won't, you're going to have to expect to defend your decision. That's the way it works in any industry.

If you don't want 2000 teenagers, try to stop treating me like a kid ;)

When I read the article, all I could hear was, "I know what's best! I got all this education! They should do what I say!" Who likes to be treated like that? "Oh, thank you for asserting your dominance over me! Now I realize I am a poor, ignorant slob. I will do what you say without question!" Um... I don't think so.

Doctors, if you are in charge, then you need to take responsibility. You're saying that you know best, like a parent. You took all the decision-making away, like a parent. You treated their disagreement with your course of action like rebellion. And your surprised your patients end up acting like children? You're not treating your patients like adults. You're the one who put yourself in the position to act like a parent. There should be no surprise why you feel that way. Your patients are not the ones to blame.


  1. This is brilliant and all too true!

    Rach xx

  2. A fantastic, fair, clear, and compassionate response. Well done!

  3. Thank you both! Apparently I really angered someone over there, so I appreciate the support here! lol